Panama Chiropractic Continuing Education

• List the electrodes necessary to perform in Electrodiagnosis nerve conduction study
• Describe the placement of the various electrodes in conduction studies of the median nerve at the wrist
• Draw a simple diagram of the carpal tunnel, defining the boundaries
• Itemize parts of a thorough chiropractic management plan for carpal tunnel syndrome

• List the differential diagnoses that may accompany various symptoms
• Describe various essential elements of the history taking process
• List several components of the mini mental status examination
• Itemize and describe several tests of cerebellar function
• Contrast and compare aspects of malingering and somatoform disorders
• Use proper language and nomenclature when producing a report for referring physicians
• Recognize aspects of functional illness

• Evaluate an unrehearsed, real doctor/patient encounter; regarding a case of an adult female patient who complains of lower back pain; pain radiating down her left lower extremity to her heel; weakness in her thighs; and unsteadiness.
• Develop improved skills in obtaining an accurate case history and performing a neurological examination of patient’s presenting with pain, weakness and unsteadiness.
• Improve interpretation of relevant clinical findings of patient presenting with pain, weakness and unsteadiness.
• List the clinical presentations of various complaints and the approach to diagnosis of patient’s presenting with pain, weakness and unsteadiness.
• Consider the differential diagnoses of patient’s presenting with pain, weakness and unsteadiness.

• List the differential diagnoses that may accompany various symptoms.  
• Describe various essential elements of the history taking process.
• List differential diagnoses for this and similar cases.
• Itemize and describe several tests of lower extremity motor and reflex function.
• Recognize a true extensor toe sign from an equivocal or false finding.
• Contrast and compare aspects of various disorders causing cervical spine myelopathy.   
• Use proper language and nomenclature when producing a report for referring physicians.
• Recognize aspects of spinal cord disease.

• List the differential diagnoses that may accompany various symptoms. 
• Describe various essential elements of the history taking process.
• Use proper language and nomenclature when discussing brain injury.
• Recognize aspects of so called “post concussion syndrome” or Mild Traumatic Brain Injury (mTBI).
• Recite levels of consciousness.
• Discuss scoring criterion when using the Glascow Coma Scale.
• Identify abnormal imaging findings associated with concussion on diffusion tensor tractography.
• Define and describe “myoclonic jerks”.

• This allows you to purchase all 20 hours of 206 level courses. Please see the educational objectives listed for each individual 206 module

• Compare and contrast neuronal cells from the neuroglial cells.
• Identify various types of neurons of the peripheral and central nervous system.
• Describe the types of neuroglial cells found in the central nervous system and peripheral nervous system.
• Categorize the types of mammalian nerve fibers by neuron a diameter, conduction velocity and susceptibility to compression.
• Describe the incidence and prevalence of dizziness as a complaint.
• Define the term “motor unit” from a clinical perspective.
• Compare and contrast type one and type two muscle fibers.
• Identify anatomical components and describe physiological function of the cell membrane.
• Define the terms summation and generator potentials.

• Define the terms “electrodiagnosis, nerve conduction study, needle electrode examination, late responses and evoked potentials”.
• Identify the various components of the action potential recording.
• Compare and contrast synaptic versus electrical nerve stimulation.
• Recite the components of the modern electromyographic machine.
• Describe the different types of electrodes used in an electrodiagnostic examination and include the purpose and benefits/drawbacks to each type.
• Categorize the types of electrodiagnostic testing.
• Discuss performance and use of electrodiagnostic testing, including conduction studies and latencies, late responses (including the “H” reflex and “F” wave) and evoked potentials.
• Properly order and interpret the results of electrodiagnostic testing.

• Define the terms “spasm, interexaminar and intraexaminer reliability, global myoelectric activity and muscle fatigue”.
• Identify the various components of the modern paraspinal electrode EMG machine. recording.
• Compare and contrast the use of surface electrodes in the traditional electromyographic examination versus the paraspinal surface electrode electromyographic examination.
• Recite several scientific studies regarding paraspinal surface electrode electromyographic, and strengths and weaknesses of each study.
• Describe tissue filtering, best ways to overcome it, and explain its significance in obtaining useful data.
• Recite the names of the paraspinal musculature organized by their depth, action and activation response.
• Discuss performance and utility of the test for the “flexion relaxation” phenomenon.

• This allows you to purchase all 12 hours of 207 level courses. Please see the educational objectives listed for each individual 207 module

• List several textbooks on electrodiagnostic medicine and discuss the benefits and limitations of each text.
• Recite several applications of electrodiagnostic medicine and discuss the utility of each of the tests performed.
• Describe the components required to perform an electrodiagnostic examination.
• Compare and contrast peripheral nerve injury classifications.
• Define some of the current terminology used in electrodiagnostic medicine.
• Compare and contrast the different types of electrodes used in electrodiagnostic medicine.
• Describe terminal motor latencies.
• Describe sensory and motor conduction velocities and studies.
• Describe electromyography.
• Discuss orthodromic and anti-dromic testing.
• Define motor unit potentials and discuss the normal and abnormal phases.
• Describe the varieties of evoked potentials and discuss the clinical utility of ordering each test.
• Describe the varieties of late potentials and discuss the clinical utility of ordering these tests.
• Identify the relevant neuroanatomy of the peripheral nervous system.
• Demonstrate median and ulnar nerves and the position of the various electrodes in common motor and sensory electrodiagnostic studies of the median and ulnar nerves.
• Discuss the conditions and circumstances when electrodiagnostic testing of the central nervous system may be beneficial or necessary.
• Describe the various electrodiagnostic procedures for the peripheral nervous system.
• Differentiate between motor unit potentials (MUP’s), fibrillations, positive sharp waves and sensory nerve action potentials (SNAP’s). 
• Contrast and compare electrodiagnostic tests for extremity complaints such as weakness and sensory loss.
• Define the role of electrodiagnosis in clinical practice.

• Compare and contrast Compound Muscle Action potential (CMAP), Sensory Nerve Action Potential (SNAP) and Motor Unit Potential (MUP).
• List the components of a spinal cord alpha motor neuron.
• Describe the basic structure of Schwann Cells and myelin.
• Discuss the role of Schwann Cells and myelin in action potential transmission.
• Recite the levels of the neuraxis which may be involved in disease that is detectable by electrodiagnostic testing.
• List the types and levels of nervous system compression.
• List common reasons and disorders for referral for electrodiagnostic testing.
• Describe a routine electrodiagnostic encounter.
• Demonstrate the position of electrodes in a typical median nerve study through the carpal tunnel.
• List the most common neuropathies of the upper and lower extremities.
• Compare and contrast typical electrodiagnostic findings for radiculopathy versus neuropathy. 
• Define and discuss the “Gold Standard” portions of the electrodiagnostic examinations.
• Discuss single fiber EMG.
• Identify the components of the needle EMG examination and discuss how various pathological conditions might be demonstrated by each component of the examination.
• Describe the morphology of positive sharp waves, fibrillations and motor unit potentials.
• Describe the morphology of positive sharp waves and fibrillations.
• Identify normal from abnormal patterns of muscular recruitment under minimal, moderate and maximal muscle contraction. 
• List various causes of radiculopathy.
• Discuss the history of radiculopathy through time.
• Contrast and compare various causes of radiculopathy.
• Discuss the need for and types of advanced imaging following abnormal findings on an electrodiagnostic examination.
• Discuss the utility of electrodiagnosis to the Doctor of Chiropractic.

• Recite relevant anatomy of the peripheral nervous system including the brachial plexus, upper limb nerves, lumbosacral plexus and lower limb nerves.
• Define and draw the brachial plexus.
• List the nerves of the upper limb.
• Compare and contrast the anatomy of the median and the ulnar nerves.
• Describe innervation of the major nerve branches of the major nerve divisions of the brachial plexus.
• Discuss the most common compressive lesions of the upper extremity involving the peripheral nervous system.
• List the muscles most commonly tested during EMG of the upper extremity.
• Define and draw the lumbosacral plexus.
• List the nerves of the lower limb.
• Discuss the most common compressive lesions of the lower extremity involving the peripheral nervous system.
• List the muscles most commonly tested during EMG of the lower extremity.
• Discuss the distinction between motor and sensory neural fibers and salutatory versus local circuit conduction.
• Compare and contrast the two types of compound potentials and discuss waveform morphology and parameters.
• Describe effects and patterns of demyelination.
• Describe the effects of axonal loss.
• Identify the electro-physiologic changes that may be noted in disease of the neuromuscular junction.
• Discuss late responses (F-waves and H-Reflexes) and describe the performance and clinical significance of each.
• Identify components involved in the tendon tap response.
• Thoroughly discuss all aspects of median and ulna nerve testing, including common congenital anomalies that are like to be encountered in the patient population.

• This allows you to purchase all 18 hours of 208 level courses. Please see the educational objectives listed for each individual 208 module

Hour 1

• Recite general information regarding incidents and prevalence of multiple sclerosis in the United States, the United Kingdom and Canada.
• Describe the pathophysiological process believed to be responsible for the most common types of multiple sclerosis.

Hour 2

• Recognize the common signs and symptoms of a patient presenting with demyelinating disease.
• Recognize typical lesions in the brain and spinal cord associated with multiple sclerosis on MRI studies.
• Define the McDonald criteria for the diagnosis of multiple sclerosis.

Hour 3

• Identify various blood tests for diseases that may mimic multiple sclerosis.
• Compare and contrast the category types of multiple sclerosis.
• Describe the common medical treatment for multiple sclerosis.

Hour 4

• Recite studies associated with complementary and alternative approaches to management of patients with multiple sclerosis.
• Synthesize a plan for the management of patients with multiple sclerosis.

Hour 1

• Recite statistics regarding the percentage of primary versus secondary tumors found in the central nervous system.
• Recognize the signs and symptoms of a patient with an intracranial or spinal canal tumor.

Hour 2

• Describe the pathophysiological process associated with neoplasia.
• Discuss the most common types of primary intracranial tumors, metastatic neoplasms and other spinal cancers.

Hour 3

• Identify advanced imaging studies of various types of nervous system tumors.
• Describe mechanisms of cerebrospinal fluid flow in their association with symptoms caused by intracranial tumors.

Hour 4

• Contrast and compare the signs and symptoms associated with tumors arising in various parts of the spinal cord.
• Discuss various forms of medical treatment for patients with nervous system tumors.

Hour 1

• Discuss the etiology of congenital conditions of the brain and spinal cord.
• Recite statistics regarding incidence and prevalence of neural tube defects.

Hour 2

• Describe common forms and categories of neural tube defects.
• Recognize various forms of neural tube defects at birth, in infant life as well as on advanced imaging studies.

Hour 3

• Identify defects of the cranial cervical junction including categorizing Chiari Malformation and discuss clinical significance and management of patients with Chiari Malformation I, II and III.
• Utilize plain film radiometrics to identify multiple forms of cranial cervical junction deformities.

Hour 4

• Discuss various congenital syndromes including Dandy-Walker Syndrome and Mobius Syndrome.
• Compare and contrast different types of developmental defects such as hydrocephalus, crainiosynostosis, achondroplasia, microcrania, and others.

• Define Neurodegeneration.
• Identify some of the core mechanisms of Neurodegeneration.
• Define and discuss oxidative stress and damage of neurons.
• List most common neurological illnesses thought to be due to long-term Neurodegeneration.
• Cite specific biochemical pathways to target therapeutically to slow down or reverse Neurodegeneration.
• Itemize common clinical findings in Parkinson’s disease, Alzheimer's disease, and multiple sclerosis.
• List the mechanisms involved in the neurodegenerative process.
• Define free radicals, articulate the issue with free radicals and describe their role in the neurodegenerative process.
• Discuss the role of glial cells in regard to Neurodegeneration.
• Itemize ways to increase the Nrf2 pathway.
• Discuss glutathione and list specific methods to increase glutathione levels.
• List dangers found in regard to genetically modified foods.
• Compare and contrast normal mitochondrial structure and function with dysfunctional mitochondria with attention to free radical damage to my no conjugal proteins and mitochondrial DNA.
• Discuss the therapeutic role of essential fatty acids (EFA's), Acetyl-L-Carnitine, and coenzyme Q-10.
• List and discuss methods for laboratory evaluation of systemic inflammation.
• Itemize issues associated with the "leaky gut" syndrome, including aspects of inflammation, relation to diabetes, and Zonulin.

Hour 1

• Describe the most common laboratory procedures used to diagnose infections of the central nervous system, including lumbar puncture indications, contraindications and complications.
• Recite characteristics and components of normal cerebrospinal fluid.

Hour 2

• Define the acquired immunodeficiency syndrome and how it affects the nervous system.
• Discuss Lyme disease, its vectors of transmission, pathogenesis, clinical presentation, clinical diagnosis and therapeutic options.
• Compare and contrast stage I, stage II and stage III Lyme disease.

Hour 3

• Identify multiple types of infections capable of producing spinal meningitis and encephalitis.
• Compare and contrast bacterial meningitis from viral meningitis.
• Discuss serious nervous system toxins such as tetanus and botulism.

Hour 4

• Discuss other nervous system infections including brucellosis, psittacosis, syphilis, tuberculosis, sarcoidosis, rickettsial, protozoan, viral and fungal infections of the nervous system.
• Recognize and act appropriately in cases of suspected Reye syndrome.
• Recite and perform appropriate universal precautions necessary to avoid the transmission of communicable diseases in the chiropractic practice.

• This allows you to purchase all 15 hours of 209 level courses. Please see the educational objectives listed for each individual 209 module

• Define and discuss professional boundaries
• Define and discuss sexual misconduct
• Sensitize the D.C. To Issues Relating to Sexual Interaction with The Patient
• Discuss the problem of sexual misconduct, either real or perceived
• Define and discuss specific examination procedures
• Provide methods for recording examinations and incidents
• Discuss case of alleged sexual misconduct
• Discuss strategies to avoid misunderstandings that may lead to charges of sexual misconduct

• Recite the incidence and prevalence of Carpal Tunnel Syndrome.
• Discuss the cost of Carpal Tunnel Syndrome on society.
• Identify disorders and situations that Carpal Tunnel Syndrome.
• Describe the common symptoms of Carpal Tunnel Syndrome.
• Define the anatomical boarders of the Carpal Tunnel Syndrome.
• Differentiate the methods of Carpal Tunnel Release Surgery.
• Describe the scientific literature comparing different methods of Carpal Tunnel Release Surgery.

• Review items included in the State and American Chiropractic Association "Principles of Chiropractic Ethics".
• Define and distinguish between principles of philosophy, ethics and morality. 
• Explore the concept of "The Greater Good".
• Differentiate general concepts of what is right and wrong, from personal decisions of what is right and wrong.
• Define the term "Fiduciary Responsibility".
• Give examples of "Ethical Dilemmas" that might face a doctor of chiropractic and provide discussion of alternative thoughts.
• Discuss issues of “boundary crossings & violations” in regard to chiropractic practice.

• Recite the types of Thoracic Outlet Syndromes and identify which types are “real” and which are disputed.
• Demonstrate different clinical maneuvers designed to identify Thoracic Outlet Syndromes.
• Identify the anatomical structures thought to be responsible for entrapment in the various Thoracic Outlet Syndromes.
• Discuss the significance of the nine fibrous bands discussed by Roos.
• Describe the anatomical and physiological changes that are thought to occur post-accident, resulting in a traumatic variety of Thoracic Outlet Syndrome. 
• Differentiate the compressive causes of upper extremity paresthesia using orthopedic and neurological testing.
• Contrast and compare the resultant clinical profile expected with upper extremity compression of vascular structures versus compression of neural structures.
• Define and perform orthopedic and neurological tests used to determine upper extremity compression of neurovascular structures.

• Outline topography and discuss internal anatomy of the cortex.
• Illustrate and list functions of the various lobes of the brain.
• Identify and describe anterior and posterior intracranial circulatory patterns.
• Relate cortical anatomy with electrode placement when eliciting somatosensory evoked potentials.
• Identify irrigation distribution of all major intracranial arteries.
• Diagram irrigation to the levels of the spinal cord.
• Describe intracranial venous drainage of the skull and differentiate between dural sinuses, boney sinuses and cerebral veins.
• List areas of the cortex responsible for vision, hearing and touch and explain their interaction with the association cortex.
• Give examples traits and characteristics which are associated with hemisphere dominance.
• Define and differentiate the agnosias, such as apraxia, aphagia, etc.
• Define constructional apraxia, and discuss the clinical significance.
• Quantify the incidence of various types of neurovascular disease.
• Contrast and compare strokes from a vascular anatomical and etiology viewpoint.
• List and discuss choices for various forms of imaging based upon suspected stroke etiology.
• Identify treatable, untreatable and possible risks for cerebrovascular accident. 
• Identify medical and conservative options for treatment of cerebrovascular accident risk factors.

• Compare and contrast chiropractors of the 1940s with modern day chiropractors.
• Define neuropathy.
• Recite the major points related to chiropractic physical rehabilitation of neuropathy.
• Contrast and compare medical treatment of polio in the 1940s, to chiropractic treatment of polio at the same time.
• List potential reasons related to public hygiene which may account for disease epidemics.
• Discuss facts related to "Sister Kenny" in regard to her credentials, her claims, and her notoriety.
• Itemize the early chiropractic colleges and discuss Willard Carver school of thought and the "mixers".
• Critically evaluate the world health organization's campaign to eradicate polio.
• Discuss the ethics of herd immunity.
• Compare and contrast individual interests vs. societal interests.
• Discuss the types, risks and benefits of the inactive polio virus (injected).
• Discuss the risks and benefits of the oral polio virus (live, attenuated).
• List the types of wild polio virus.
• Define vaccine associated paralytic polio mile items (VAPP)
• Define circulating vaccine derived polio virus.
• Discuss the concepts of risk: benefit ratio.
• Discuss the transmission and pathophysiology and list the presenting signs and symptoms of a polio virus infection.
• List the different types of Polio virus infection.
• Quantify the various affects of the polio virus on different groups of individuals.
• Itemize ethical concerns regarding Dr. Jonas Salk.
• Graph the incidence of polio cases after other vaccines were introduced and after the definition of a polio diagnosis was altered.
• Discuss SV40 tainted vaccines.
• Define acute flaccid paralysis as it relates to new “non-polio” outbreaks.

• This allows you to purchase all 8 hours of 210 level courses. Please see the educational objectives listed for each individual 210 module

• Evaluate the subluxation complex and the chiropractic adjustment.
• Develop a working knowledge of the neurology of spinal joints and how this may be altered by a spinal subluxation complex.
• Consider the safety and effectiveness of chiropractic adjustments through a review of the scientific literature and understanding of a decline in literature integrity and literature bias.
• Consider the scientific literature regarding chiropractic adjustments and a measurable decrease in pain.
• List and identify the components of the synovial joint and spinal joint mechanoreceptors.
• Consider activities in and around the nervous system that occur after nerve tissue injury.
• Distinguish different levels of nervous system involvement in neuropathic pain, including the peripheral neuron, the dorsal root ganglia and the dorsal horn neurons, as well as concepts of descending inhibition.
• Analyze the goals and effects of the chiropractic adjustment on pain.
• Examine the scientific literature regarding the physiological effects of a subluxation and adjustment upon non-musculoskeletal systems.

• Explain how and why documentation of a subluxation is so important for Medicare patients in chiropractic practice.
• Compare and contrast the Medicare reimbursement of chiropractic providers vs. Medical and other providers for similar services.
• Describe payments made to chiropractors, calculate the actual dollars per visit and explain what portion of payments made are considered inappropriate as medically unnecessary according to a report issued by the Department Of Health And Human Services (HHS).
• Compare and contrast non-provider services, such as drugs and durable medical devices with costs associated with chiropractic care.
• Define requirements for chiropractic services to be covered by Medicare.
• List and discuss how a subluxation may be properly documented in the medical record for Medicare patients.
• Evaluate your understanding of subluxation compared to other chiropractic providers. 
• List the various types of subluxation which may be demonstrated on xray and are acceptable to Medicare.
• List the components of the physical examination which are required by Medicare to be demonstrated in order to verify the existence of a subluxation.
• Identify the specific requirements accepted by Medicare for the initial and subsequent visits of the chiropractic patient.

• This allows you to purchase all 23 hours of 211 level courses. Please see the educational objectives listed for each individual 211 module